The aim of this study was to examine the effect of phase I cardiac rehabilitation program (CRP) on physical capacity in patients with coronary artery bypass graft (CABG). Eighty seven patients who underwent CABG in our hospital were enrolled on the study. Among them, excluding 17 during the study, the results of 70 patients were included in the final data. Subjects were classified into two groups according to the participation in the phase I CRP; participation group (n=35) and non-participation group (n=35). The CR was executed for the participation group until patients' discharge. The variables including resting heart rate (RHR), oxygen saturation, walking distance in 6 minutes, and forced expiration amount were measured at initial phase, discharge and follow-up at 1 month after discharge. From the data, descriptive statistics (mean, standard deviation) were calculated, and differences in each variable before, during, after the treatment and between groups were tested using repeated measure analysis of variance using SPSS ver. 18.0 statistics program for Window. For the effects and results with a statistical significance, post-hoc test was made using t-test. There was statistically significant difference (p<0.05) in the RHR and the walking distance in 6 minutes. While there was no significant difference in the oxygen saturation and the maximum expiration amount. As conclusion, the Phase I CRP after CABG showed a effect on the significant improvement of physical capacity by decreasing the RHR and increasing the walking distance in 6 minutes, exerting a positive influence on the recovery after the CABG operation.
Coronary Artery Bypass ; Coronary Vessels ; Follow-Up Studies ; Heart ; Heart Rate ; Humans ; Oxygen ; Transplants ; Walking

PURPOSE: To report a case of epidemic keratoconjunctivitis complicated by Alcaligenes xylosoxidans. METHODS: A 37-year-old man suffered epidemic keratoconjunctivitis in both eyes. Eleven days later, he developed a corneal ulcer in his left eye. Bacterial staining, culture, and antibiotics sensitivity test were performed from a corneal scrape. RESULTS: The cultures revealed a growth of Alcaligenes xylosoxidans, and the patient was treated with ceftazidime and levofloxacin, based on the sensitivity test results. After 21 days of treatment, the infection was resolved with mild scaring and final vision in the left eye of 20/20. CONCLUSIONS: Alcaligenes xylosoxidans should be considered a rare but potential pathogen able to produce corneal ulcer complication in epidemic keratoconjunctivitis.
Male ; Keratoconjunctivitis/*complications/pathology ; Humans ; Gram-Negative Bacterial Infections/*complications/pathology ; Corneal Ulcer/*microbiology/pathology ; Adult ; *Achromobacter denitrificans

PURPOSE: To present a case of inflammatory myofibroblastic tumor which was manifested as an idiopathic subretinal mass without underlying pathology. METHODS: The subretinal mass was surgically excised and evaluated histopathologically. Fluorescein angiography and optical coherence tomography were performed pre- and post-operatively. RESULTS: The mass was histologically composed of lymphoplasma cell infiltration and fibrous proliferation without microorganisms or malignant cells. Immunohistochemistry for smooth muscle actin revealed myofibroblasts as a major cellular component. Preoperative optical coherent tomography showed that the lesion was contiguous to the retina while inducing foveal detachment. Postoperatively, the fovea was attached with visual recovery, and the subretinal lesion did not recur during the follow up. CONCLUSIONS: Inflammatory myofibroblastic tumors may be included in the differential diagnoses of subretinal masses.
Tomography, Optical Coherence ; Retina/pathology ; Neoplasms, Muscle Tissue/diagnosis/*pathology ; Male ; Inflammation/pathology ; Humans ; Fundus Oculi ; Fluorescence ; Eye Neoplasms/*pathology ; Choroid/pathology ; Atrophy ; Angiography ; Adult

PURPOSE: To evaluate the intraocular pressure (IOP) -lowering efficacy of latanoprost in normal-tension glaucoma (NTG). METHODS: One-hundred and seventeen eyes of 63 NTG patients treated with 0.005% latanoprost once a day were enrolled in this study. Of these, 85 eyes of 47 patients were treated for 12 months. Mean IOPs were analyzed, and the mean IOP reductions from the untreated baseline were assessed after two weeks and after 1, 3, 6, 9, and 12 months of treatment. RESULTS: The mean untreated baseline IOP was 15.0+/-2.7 mmHg. After two weeks of latanoprost treatment, the mean IOP reduction from the baseline value was 2.6+/-0.2 mmHg (17.3%, p< 0.05), and after 6 and 12 months, the reduction was 2.4+/-0.2 mmHg (16.0%, p< 0.05) and 2.4+/-0.2 mmHg (16.0%, p< 0.05), respectively. Patients with a baseline IOP of > or=15 mmHg achieved significantly higher IOP reductions than those with a baseline IOP of < 15 mmHg at all follow-ups (p< 0.05). CONCLUSIONS: Latanoprost was found to be well tolerated and to significantly reduce IOP in NTG patients.
Treatment Outcome ; Time Factors ; Retrospective Studies ; Prostaglandins F, Synthetic/administration & dosage/*therapeutic use ; Middle Aged ; Male ; Intraocular Pressure/*drug effects/physiology ; Humans ; Glaucoma, Open-Angle/*drug therapy/physiopathology ; Follow-Up Studies ; Female ; Dose-Response Relationship, Drug ; Antihypertensive Agents/administration & dosage/*therapeutic use ; Aged, 80 and over ; Aged ; Adult

PURPOSE: To analysis the chronological changes of surgical strategy for early gastric cancer (EGC) in our hospital over a 10-year period. METHODS: From November 1993 to August 2003, we experienced 201 patients with EGC at Ewha Womans University Mokdong Hospital. The medical and pathologic records of these patients were reviewed retrospectively. The patients were categorized into three groups in chronological order: P1 (1993~1996), P2 (1997~2000), and P3 (2001~2003). The clinicopathological characteristics and treatment modalities among these three groups were compared. RESULTS: Of the 683 gastric cancer patients, 201 patients (29.7%) were pathologically confirmed to have EGC. The proportion of EGC gradually increased in chronological order: 19.2% in P1, 33.2% in P2 and 32.9% in P3. There were no significant differences in clinicopathological characteristics among three groups, including age, sex, location, size, gross type, histology, depth of invasion, and lymph node metastasis. Open surgery was performed in 134 patients, laparoscopic surgery in 52 and endoscopic mucosal resection (EMR) in 15. The proportion of minimally invasive surgery such as EMR, laparoscopic wedge resection, laparoscopy- assisted distal gastrectomy (LADG), and hand-assisted laparoscopic surgery (HALS) increased in chronological order: 0% in P1, 22.4% in P2 and 58.5% in P3. The postoperative mortality was 1.49% (3/201): 2 cases after open surgery, and 1 case after laparoscopic wedge resection. One case after open conventional surgery recurred. There were no significant difference in postoperative complication, postoperative mortality and survival rate among the three groups. Overall 5-year survival rate was 95.4%. CONCLUSION: The proportion of minimally invasive surgery increased during a 10-year period in our hospital. However, there were no significant differences in postoperative complication, postoperative mortality, recurrence rate, and survival rate among three chronological groups.
Female ; Gastrectomy ; Hand-Assisted Laparoscopy ; Humans ; Laparoscopy ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Stomach Neoplasms* ; Surgical Procedures, Minimally Invasive ; Survival Rate

BACKGROUND: Myocardial contrast two-dimensional echocardiography(MC-2DE) has been known to have the real time capabilities for repeat in vivo assessment of ischemic risk areas and for evaluation of the myocardial perfusion. The aims of this investigation are (1) to evaluate the feasibility of MC-2DE for the delineation and quantitation of the area at risk. (2) to determine the relationship between the extent of the echocontrast defect area(EDA) during reperfusion and the size of myocardial infarction as determined by post-mortem tissue examination, and (3) to observe serial changes in the time echo-intensity characteristics of MC-2DE during coronary occlusion and reperfusion. METHODS: Myocardial contrast echocardiographic images were made by injecting bolus 5mL of two-syringe-agitated mixture of sodium meglumine ioxaglate(Hexabrix(R)) and normal saline(2 : 3 by volume) into the aortic root before and during coronary occlusion of the left anterior descending coronary artery, distal to the first diagonal branch and during reperfusion on eight open-chest dogs. Two-dimensional echocardiographic short axis views were obtained at four anatomic levels : the apex, the low papillary muscle, the high papillary muscle and the mitral valve. The changes in EDA and echo-intensity with its wash-out half time(WHT) at the high papillary muscle level during coronary occlusion and reperfusion were measured every 15 minutes. The total EDA was measured by planimetry at 3 minutes after coronary occlusion and at 60 minutes after reperfusion. Evans blue or methylene blue were used for the measurement of the anatomic area at risk and triphenyl-tetrazolium chloride(TTC) for the measurement of the infarct area. RESULTS: The EDA measured 30 minutes after coronary occlusion(19.6%) was smaller than that at 3 minutes after coronary occlusion(24.0%, p<0.01). Then EDA at 3 minutes occlusion was strongly predictive of the anatomic extent of area at risk(EDA=0.48 Area at risk+16.95, r=0.84, p<0.05). The EDA at 60 minutes after reperfusion, which showed an irregular margin and was located within the subendocardium of the area at risk, also correlated well with the infarct area(IA)(EDA=0.78 IA+3.32, r=0.82, p=0.09). The peak echo-intensity in the ischemic area during coronary occlusion was significantly low(14.2+/-6.5 vs 73.8+/-31.7 in the non-ischemic area, p<0.01) and the WHT was delayed more in the ischemic area than in the non-ischemic area(23.2+/-2.8 sec vs 8.1+/-3.3sec, p<0.01). During the period of reperfusion, WHT in the previously ischemic area was markedly delayed compared to that in the non-ischemic area (p<0.01), although the peak echo-intensity in the ischemic area at 3 minutes after reperfusion increased modestly compared to that in the non-ischemic area(80.9+/-22.8 vs 72.7+/-8.4), suggesting the impairment in the transit of microbubbles is probably due to microvascular damage after reperfusion. There were no adverse hemodynamic or electrocardiographic effects after injection of the contrast agent. CONCLUSIONS: These findings suggest that myocardial contrast echocardiography was useful as a non-invasive technique, first, to delineate the area at risk in vivo during coronary occlusion and, after reperfusion, the infarct area, and secondly, to evaluate indirectly the state of myocardial perfusion during coronary occlusion and reperfusion.
Animals ; Axis, Cervical Vertebra ; Coronary Occlusion* ; Coronary Vessels ; Dogs ; Echocardiography* ; Electrocardiography ; Evans Blue ; Hemodynamics ; Meglumine ; Methylene Blue ; Microbubbles ; Mitral Valve ; Myocardial Infarction ; Papillary Muscles ; Perfusion* ; Reperfusion* ; Sodium

PURPOSE: To evaluate corneal biomechanical properties in eyes that had previously undergone penetrating keratoplasty (PK) using the ocular response analyzer (ORA). METHODS: We recruited 26 patients who had received unilateral PK. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and cornea-compensated intraocular pressure (IOPcc) were measured with the ORA and were compared to the measurements from the contralateral eyes that did not undergo PK. RESULTS: The CH was 8.95+/-2.59 mmHg in eyes that underwent PK and 9.78+/-1.45 mmHg in the contralateral eyes that did not undergo PK (p=0.077). The CRF was 10.26+/-2.64 mmHg in post-PK eyes and 9.75+/-1.45 mmHg in the contralateral eyes (p=0.509), and the CH-CRF was significantly smaller in post-PK eyes (-1.31+/-2.32 mmHg in post-PK eyes vs. 0.03+/-0.88 mmHg in fellow eyes, p=0.016). The IOPg and IOPcc were significantly higher in the PK group than they were in the control group. The IOPcc's were 20.81+/-7.81 mmHg and 16.27+/-2.49 mmHg in post-PK and control eyes, respectively (p=0.011); and the IOPg's were 19.22+/-7.34 mmHg and 15.07+/-3.03 mmHg in post-PK and control eyes, respectively (p=0.019). The IOPcc-g's were 1.59+/-2.81 mmHg and 1.21+/-1.30 mmHg in post-PK and control eyes, respectively (p=0.412), and the central corneal thickness (CCT)'s were 489.11+/-90.60 microm and 556.24+/-42.84 microm in post-PK and control eyes, respectively (p=0.068). CONCLUSIONS: Following PK, CH tended to decrease while CRF tended to increase, significantly decreasing CH-CRF. A significantly higher intraocular pressure and a thinner CCT following PK may have contributed to the observed changes in these corneal biomechanical parameters.
Adolescent ; Adult ; Aged ; Cornea/*physiopathology ; *Diagnostic Techniques, Ophthalmological ; Elasticity ; Female ; Humans ; Intraocular Pressure ; *Keratoplasty, Penetrating ; Male ; Middle Aged ; Postoperative Period ; Young Adult

PURPOSE: To compare the accuracy of intraocular lens (IOL) power calculation using conventional regression formulae or the American Society of Cataract and Refractive Surgery (ASCRS) IOL power calculator for previous corneal refractive surgery. METHODS: We retrospectively reviewed 96 eyes from 68 patients that had undergone cataract surgery after keratorefractive surgeries. We calculated the formula with two approaches: IOL powers using the ASCRS IOL power calculator and IOL powers using conventional formulae with previous refractive data (Camellin, Jarade, Savini, and clinical history method) or without prior data (0, 2 and, 4 mm total mean power in topography, Wang-Koch-Maloney, Shammas, Seitz, and Maloney). Two conventional IOL formulae (the SRK/T and the Hoffer Q) were calculated with the single K and double K methods. Mean arithmetic refractive error and mean absolute error were calculated at the first postoperative month. RESULTS: In conventional formulae, the Jarade method or the Seitz method, applied in the Hoffer Q formula with the single K or double K method, have the lowest prediction errors. The least prediction error was found in the Shammas-PL method in the ASCRS group. There was no statistically significant difference between the 10 lowest mean absolute error conventional methods, the Shammas-PL method and the Barrett True-K method calculated with using the ASCRS calculator, without using preoperative data. CONCLUSIONS: The Shammas-PL formula and the Barrett True-K formula, calculated with the ASCRS calculator, without using history, were methods comparable to the 10 most accurate conventional formulae. Other methods using the ASCRS calculator show a myopic tendency.
Cataract ; Humans ; Lenses, Intraocular* ; Methods ; Refractive Errors ; Refractive Surgical Procedures* ; Retrospective Studies

Substernal extension of a goiter into the thoracic inlet endows a generally benign neck mass with morbid potential. The reported incidence varies between 1% and 15% of all thyroidectomies performed. Whether all patients with a substernal goiter should undergo an operation or whether the operation should be performed selectively remains controversial. From May 1989 to March 1996, 10 patients underwent thyroidectomies for substernal goiters, and those cases of resected substernal goiters have been reviewed to access the symptoms and signs that brought patients to surgery: the size and the position of goiter, the preoperative work-up, the risk associated with the operation, and the histopathologic state of the goiter. There were 3 male and 7 female patients, and their ages ranged from 40 to 68 years. The chief complaints were cervical mass (4), dyspnea (2), facial edema (1) and chest pain (1). No symtomatic cases (2) were also found. The average mass size was 8.4 cm (5-14 cm) and the average weight was 109 gm (41-350 gm). Although chest film was the most used, computed tomography was by far the most useful study. Thyroid scans often failed to show the substernal goiter. Fine-needle aspiration was not helpful because of inaccessibility. In the majority of the patients (7 cases), the substernal goiters were removed by a cervical incision. Three cases of goiters located deep to the carina level required a combined cervical and sternotomy approach or thoracotomy. In the cervical incision group, the complications were transient hypocalcemia (1) and unilateral recurrent laryngeal nerve injury (1). In the combined cervical and sternotomy approach or thoracotomy, unilateral recurrent laryngeal nerve injury (1) and bilateral recurrent laryngeal nerve injury (1) and mediastinitis (1) were the complications. An occult papillary carcinoma, which was not identified preoperatively, was found in one case. Removal was almost always accomplished via cervical incision and with low morbidity and no deaths. Also, the substernal goiters revealed unusual symptoms and signs, such as dyspnea, facial edema and chest pain, compared to usual thyoid goiters and were relatively bigger in size. In conclusion, most substernal goiter above the carinal level could be removed by cervical incision with a low rate of complication. The threat of compression, the substantial chance of malignancy, and the safety of resection mean that the presence of a substernal goiter is an indication for surgery.
Bays ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Chest Pain ; Dyspnea ; Edema ; Female ; Goiter ; Goiter, Substernal* ; Humans ; Hypocalcemia ; Incidence ; Male ; Mediastinitis ; Neck ; Recurrent Laryngeal Nerve Injuries ; Sternotomy ; Thoracotomy ; Thorax ; Thyroid Gland ; Thyroidectomy

PURPOSE: To investigate the clinical outcomes of primary pterygium excision combined with free conjunctival autograft. METHODS: The medical records of 112 patients (129 eyes) who underwent pterygium excision and free conjunctival autograft for primary pterygium were retrospectively reviewed for recurrence and postoperative complications and the outcomes compared with pterygium excision combined with amniotic membrane transplantation, conjunctival flap, or simple conjunctival closure. Additionally, the surgical outcomes were evaluated in relation to the intraoperative use of mitomycin C. RESULTS: Postoperative recurrences were observed in 3 of 129 eyes (2.3%) that received pterygium excision and free conjunctival autograft, 2 of 10 eyes (20.0%) that received pterygium excision with amniotic membrane transplantation, 1 of 10 eyes (10.0%) that received pterygium excision with conjunctival flap and 1 of 12 eyes (8.3%) that received pterygium excision and simple conjunctival closure. Therefore, the recurrence rate was significantly lower in patients with conjunctival autograft than in those without (p = 0.024, Breslow-Wilcoxon test). Additionally, recurrence was observed in 1 of 10 eyes (10.0%) in patients that underwent pterygium surgery when mitomycin C was used intraoperatively and in 2 of 119 eyes (1.7%) without the use of mitomycin C. CONCLUSIONS: Pterygium excision combined with free conjunctival autograft is an effective and safe surgical procedure to treat primary pterygium.
Amnion ; Autografts* ; Humans ; Medical Records ; Mitomycin ; Postoperative Complications ; Pterygium* ; Recurrence ; Retrospective Studies